Differential diagnosis of groin pain in athletes

Groin pain is a common complaint in athletes, particularly among those participating in kicking and pivoting sports. Groin pain can arise from a wide variety of causes, or some combination thereof, ranging from musculoskeletal disorders to abdominal and genitourinary pathology. Many causes of groin pain in the athlete are found in the hip, both extra- and intra-articular. Muscle tendon disorders of the adductor and hip flexor groups are common extra-articular sources of groin pain in athletes. Sports hernia, osteitis pubis, and sacroiliac joint dysfunction are also part of the differential diagnosis, as are nerve injuries and stress fractures. Common intra-articular causes of groin pain in the athlete include labral tears and femoroacetabular impingement (FAI). Arriving at the correct diagnosis depends on keeping an open mind while collecting a careful history and conducting a thorough physical examination. Imaging can help and is often necessary. Additional diagnostics such as EMG and nerve conduction studies may be required.